Health Care in Russia

Summary

Russia is the largest country in the world and risks vary across its great expanse. Most travelers and expats will stay in larger urban areas though. The Caucasus region sees an ongoing, low-intensity insurgency now in its third decade and is best avoided. The immediate border with Ukraine should be visited only after obtaining fresh intelligence on the local situation.

Crime
Both ordinary and violent crime pose a risk, as do the presence of organized crime which sometimes collude with state authorities such as corrupt police. Major urban areas have high rates of crime and travelers and expats need to take special precautions to handle this risk.

Terrorism
Russia has been targeted by terrorists many times in the last 10-15 years, some domestic and some international in origin. At this point the insurgency in the Caucasus and Russia’s activities in Syria against IS/ISIL means the country faces a real risk, we would caution travelers to adopt at least basic measures. Minimize or avoid the use of public transport, avoid venues where crowds gather such as stadiums and theatres and avoid military, police and government buildings.

Health insurance and health care
Health insurance is simply a must-have. The public health care system is substandard. Travelers and expats should make sure they have proper health insurance which allows them to use the better and must more expensive private sector.

Politics
Russian politics are de facto authoritarian. Real democracy was thrashed by Putin in the 2000s and the institutions of State are today weak, whereas informal networks wield real power. Opposition does exist and is tolerated, but only to some extent. Anti-western sentiment has grown in recent years. It is best not to discuss politics with locals and any and all demonstration and protest should be given a wide berth.

International relations
Russia is currently engaged in military operations in Syria. This should not affect travelers or expats directly but do note the increased risk of terrorist attack. Russia has also attacked and annexed parts of Ukraine, the Crimea Peninsula which is unrecognized by the international community. Travel to Crimea may cause problems with authorities as consular assistance may not be possible, and for those traveling to Ukraine also travel to Crimea may cause problems with immigration authorities there.

Political background

Russia is a presidential, federal republic. At the federal level executive power is vested in the president who appoints the cabinet, while legislative power is vested in the Duma. At the regional level governors exert executive power, but do note that there are significant variations in terms of how much power is vested locally as the system is rather complex.

In real terms Russia is ruled from the Kremlin by president Putin and his entourage, mainly made up of powerful members of the army and security forces, and support from the business elites who have learned not to cross the Kremlin too much. The Duma has little real influence. At the regional and local levels some governors have almost czar-like powers. This concentration of power in the hands of the few, and the attendant dependency of the judicial system which the government has thoroughly politicized, serves to create a fertile ground for corruption – or more accurately for a nexus between state power and special, private interests.

Travelers and expats are reminded of these facts. Do not discuss politics and do not cross the law in Russia. Be mindful that you may subjected to arbitrary state power if you fall afoul either central or local authorities. Avoid any and all demonstrations and rallies as police may act in a heavy handed manner. In general the police should only be contacted if you have no alternatives as their behavior may tend towards the boorish. If arrested you should demand to contact your embassy immediately.

There are currently no realistic prospects of Russia reverting to the bad old days of the 1990s which saw tanks on the streets of Moscow, but the autocratic rule of Putin cannot continue in its present form. The petrodollars have dried up as oil prices have slumped, while the Kremlin is engaged in two costly conflicts abroad at the same time. Russia’s economy will find it hard to cope in the long run, and substituting nationalist talk for bread and butter only works for so long.

Crime & kidnapping

Crime is a very significant problem for foreigners, who may be targeted by crimes of opportunity for their perceived wealth and also more directly targeted by organized gangs or indeed kidnapping, although the latter is infrequent. Foreigners have been killed and injured in recent years.

Crimes of opportunity include a wide range of risks such as pick-pocketing and bag-snatching, but also more serious risks such as mugging, assault and sexual assault. While Russia’s major cities may well boast a lively evening entertainment scene, this should be avoided if possible or visited only with a group of trusted companions. Drink-drugging and bill-inflation are special risks here.

Transport is best done in a company or hotel car, or by radio-taxi. As said, it is best to travel in a group and this is most important for female travelers after hours. Never hail street taxi. Travel should be completed by nightfall. Credit cards should only be used in high-end hotels and inside banks as fraud is a real problem.

If you are faced by armed criminals, do not resist. Try to remain calm and avoid eye-contact and sudden movement. Hand over any and all valuables on demand without hesitation. Motorists should not stop

High-profile travelers and expats may need additional measures, including against extortion and kidnapping. These are specialist tasks. Westerners are sometimes subjected to extortion, while less often to actual kidnapping.

Health care

Health insurance is very important. The public health care system is substandard even if universal for Russian citizens. Some foreigners may be covered by the public system depending on their nationality as some states have bilateral agreements offering free treatment. However, due to the poor standards travelers and expats should make sure they have health insurance which allows them to use the better and must more expensive private healthcare sector.

Health insurance will open the door to the private sector, which offers acceptable standards of care and treatment for those who can pay for it. These facilities are mainly available in the larger cities and this should be noted if you need to travel to rural areas including extraction sites. English speaking staff should be available in the major cities’ private facilities, but if possible do bring a Russian speaking colleague.

Health insurance should always include cover for medical transportation, medical evacuation and repatriation in case treatment of an acceptable quality is not at hand.

For those needing prescription medicines it is best to bring a supply (with documentation). Russian health care facilities may offer various generic versions of drugs due to low supplies or lack of imports. Needles to say it is important to verify the quality of such products if used.

In an emergency an ambulance may be requested by dialing 112. Response may be lackluster.

Russia being Russia selection of hospitals and clinics is very important. There are some parts of the private sector which offer but a mediocre quality at an extravagant cost.

Cultural Considerations

Briefly on cultureTo people at home within a given culture, there will be a set of norms and values which governs everyday life, often in an almost subconscious manner. Think of how people tend to interact back home: How are relations between age-groups, genders, colleagues, religious groups, employers and employees, citizens and state etc. usually defined? Then consider that these relationships and the norms and even rules which govern then are very familiar to you – indeed you will probably consider them almost natural. This is the effect of culture upon people living within a group.

But the world is a diverse place, and cultures are very different around the globe. To complicate matters further cultures are anything but static; indeed, by their very nature they are always in flux. A country will often be home to different cultures as well, although it may sometimes be possible to identify a preponderant culture within a country.

Cultural differences and travel securityWhen you travel to a country or an area with a significantly different culture from your own this may affect your safety. This effect may take several different shapes.

The most basic effect is that of simply being different, of sticking out, familiar to any tourist in the world: The local population has little trouble identifying you as a traveler, tourist or expat. This raises your profile and increases your vulnerability, especially to street crime and scams, which may be serious in high-risk countries. While probably difficult to avoid, this basic fact should always be borne in mind. You will be more exposed and have less instinctive understanding of your surroundings that would the case back home.

Examples of specifics: Locals laws and customsThere may be more specific effects as well. Local laws will reflect the local culture, and this can have a very direct effect, e.g. bans on specific products, behavior or rules affecting interaction between people. Classic examples include a ban on consumption of alcohol or drugs, limits on driving, bans on homosexuality or laws governing interaction between unmarried couples. Clearly local laws must be obeyed as they apply to all.

Health care and health insurance may also be affected. This is most often the case when it comes to how much practical support relatives are expected to supply at a hospital or clinic (e.g. food and basic care), or how much access family members can have to a hospitalized dependent.

But specific effects may also be subtle. As a foreigner, it is easy to break local customs unwarily, which may cause offense or resentment. This can be embarrassing of course; however, to transgress deeply held convictions e.g. of a political or religious nature may trigger hostility. Travelers and expats should always refrain from any political debates with locals, and should at least make themselves familiar with local customs and religious beliefs.

When it comes to religion specifically sensitivity may be high. If confronted with locals, it is best to express agreement with their stated convictions in a discussion. Most often it is not a problem to belong to a different major faith or denomination, but it may be. It is almost always a bad idea to confess to atheism if confronted by zealots.

Always remember that, even though you may disagree vehemently with elements of the local culture, you are the visitor. Do not try to convince locals of “the errors of their ways” and never, ever proselyte.

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